Aged Care Quality Bulletin #54 - June 2023

Group of ethnically diverse elders smiling

Commissioner’s message

Earlier this month, over 700 leaders and senior staff from residential and home services joined us in Melbourne for our National Aged Care Providers Conference to discuss regulation of the sector in the context of the reform program underway.

We were delighted to welcome the Minister for Aged Care, the Hon Anika Wells MP, as our opening speaker, and the initial buzz generated was sustained over the course of the entire conference. My thanks to all participants who travelled from across the country to spend time together. 

We sought to ‘lift the curtain’ on the Commission and provide information and insights on our approach to resolving complaints about services, assessing and monitoring the quality and safety of care, and taking compliance and enforcement action. It was great to see the high level of engagement by attendees – through the Q&A sessions, poll surveys and informal conversations. The Commission gained a lot from participants’ questions and candid feedback on their experiences with us, and we hope everyone found it to be a useful learning opportunity.

Plenary sessions included presentations by Maree McCabe AM (Chair of the Commission’s Advisory Council), me, Michael Lye (Deputy Secretary Ageing and Aged Care, Department of Health and Aged Care), and Ian Yates AM (Interim Inspector-General of Aged Care).

We also talked about the strengthened Aged Care Quality Standards. We discussed how these stronger standards will contribute to improved care delivery for consumers and how both providers and the Commission need to prepare ourselves for their introduction.

You can view the full program, presentations and a photo gallery on our website.

A highlight of the conference was a session featuring a couple of providers talking about how they work with their consumers as partners in the design and delivery of their care. Our panellists shared some very practical examples of how they are supporting the people they are caring for to have a voice and choice in the care they receive, and there was the added bonus of hearing directly from the older people themselves via pre-recorded video.

An over-arching conference theme was that working together, we can achieve better aged care. Attendees took full advantage of the opportunities for networking, and sharing experiences and good ideas (including during the dinner). For our part, the Commission explained our regulatory approach and listened carefully to the feedback provided.

In my closing comments at the conference, I noted that each of us in the sector has agency and choice. We get to decide what we’re going to aim for, how we’re going to get there, and what actions we will take to make it happen. In short, it is open to each of us to commit to travelling along the path towards excellence and best practice, knowing that that will deliver the best possible experience for people receiving aged care.

The post-conference feedback submitted by participants has confirmed the value of the event, and on that basis, I am really pleased to announce that we are already planning next year’s conference (which is likely to be held in April 2024). Keep an eye out for more details in the months to come. Your suggestions for topics and presenters would be welcome, and can be sent to agedcarereform@agedcarequality.gov.au.

Our reports

Sector performance – latest insights 

The Commission’s latest aged care Sector Performance Report is now available. It includes information, data and insights into how aged care providers performed in Quarter 3 (Q3), from 1 January to 31 March 2023. The data in the report can help providers consider areas for improvement. 

It includes new sections on worker regulation, prudential and financial regulation, and the Commission’s campaign to maintain providers’ focus on effective infection prevention and control measures.

In Q3: 

  • Site audits of residential services increased by 26%, to 490 (Q3) compared with 362 (Q2).
  • 398 residential care services were reaccredited this quarter compared with 373 in Q2, a 7% increase. There was a 40% decrease in the number of services accredited for less than 3 years, from 50 to 30.
  • The number of residential care services non-compliant with one or more of the Aged Care Quality Standards dropped by 34%, from 133 to 88. The Commission used risk profiling to prioritise higher risk services early in the pandemic. With lower risk services now being audited, we have seen quarterly falls in findings of non-compliance.
  • Personal care and clinical care, Quality Standard 3, is the most frequent area of non-compliance with the Quality Standards. It’s also the most frequently cited standard in non-compliance notices and directions.
  • This is also reflected in complaints data for residential care, where 6 out of the top 10 complaint issues were clinical. This includes medication administration and management, personal and oral hygiene, falls, wound management and continence management. This is consistent with past quarters.
  • Organisational governance, Quality Standard 8, was ranked second in findings of non-compliance in residential care. This is consistent with Q2.
  • The number and sufficiency of workers was the third most complained about issue in residential care. We have also seen more complaints this quarter about staff behaviour, which was the seventh most complained about issue.
  • For home services, complaints relating to financial issues such as fees and charges, reimbursements, and communication about fees, made up 5 of the top 10 complaint issues.
  • Non-compliance among home service providers was most frequently found in Quality Standard 8, organisational governance, and in Quality Standard 2, ongoing assessment and planning with consumers.
  • We issued 20 banning orders against individuals. 19 were based on suitability for individuals to be providing aged care and one was made in response to immediate or severe risk to consumers.

You can find more data and analysis on this quarter’s results and download the report from the Commission’s website.

Aged care reforms update

Are you prepared? Meeting consumer advisory body requirements

Providers of residential services and/or home care packages who were operating prior to 1 December 2022 have until 1 December 2023 to implement new requirements in relation to their governance arrangements. These are part of the Strengthening Provider Governance reforms.  

From 1 December 2023, existing approved aged care providers must write to their consumers offering to establish a consumer advisory body, and repeat this exercise at least every 12 months. New providers are required to meet this obligation from the date of their approval.

Consumer advisory bodies can provide valuable feedback to governing bodies. They can also help leaders to build a person-centred culture committed to providing safe and high-quality aged care.

Governing bodies must consider comments and suggestions made by consumer advisory bodies about the standard of care and services offered. Governing bodies must also explain, in writing, how they considered a consumer advisory body’s feedback.

The Commission encourages approved providers to take action now, to ensure that they are ready to meet the new requirements for consumer advisory bodies. We recently published a series of factsheets and posters for providers and consumers about consumer advisory bodies on our website.

Watch this video to hear directly from Maggie, Jo and Jan from the Residential Advisory Committee at Queen Victoria Care in Tasmania as they talk about what matters to them, and how they partner with management in the design of their care.

Further information can be found on our website.

Workforce-related responsibilities from 1 July 2023

From 1 July 2023, new responsibilities will apply to residential aged care providers including a requirement to have a registered nurse (RN) on-duty and onsite 24/7. From 1 October 2023, providers will also need to meet mandatory care minute targets delivered to residents.

The 24/7 RN and care minutes responsibilities aim to give older people living in residential care confidence that they will receive the care, especially the clinical care, that they need.

To support approved providers to understand these new responsibilities and the regulatory approach that will be taken by the Commission, last month we released a regulatory bulletin and held a webinar. In addition, the Commissioner wrote to all residential aged care providers.

A new fact sheet for providers is also now available on our website.

If providers don’t have an RN on site and on duty 24/7 from 1 July this year, it's essential that they have strategies in place to make sure that residents are safe and receive the care that they need around the clock. It's also vital that providers are doing all they can to recruit and retain the staff they need.

Where facilities are not meeting the 24/7 RN responsibility, the Commission will consider the steps that a provider has taken to fulfil their responsibilities. This will include the efforts they have made and continue to make to recruit and retain RNs, and the clinical governance and clinical care arrangements they have put in place to ensure that the clinical needs of residents are met.

Where providers can demonstrate that they are actively working to comply with their responsibilities, the actions we take will be different from a situation where a provider is unable to demonstrate a suitable response, or deliberately avoids meeting their obligations and may be placing residents at risk of harm.

Importantly, if providers are non-compliant with the 24/7 RN responsibility but can show ongoing efforts to comply, and they are providing safe and quality care to residents at all times, the Commission is unlikely to take enforcement action. Our focus will be, as it always is, on residents and ensuring that they are receiving safe and quality care. 

A fact sheet on 24/7 RNs in aged care homes is available for residents, their families and advocates. Providers are encouraged to share this resource in their services. The fact sheet is available on the Department of Health and Aged Care’s website.

Stay up to date by visiting our 24/7 registered nurse cover and care minutes web page.

New regulatory model for aged care

The Government is planning to introduce a new regulatory model for aged care as part of the new Aged Care Act. The new model is being designed to increase protections for older people and support providers to continuously improve.

The Department of Health and Aged Care has drafted strengthened Aged Care Quality Standards as part of the proposed new model. The new model explains how the draft strengthened Quality Standards are expected to apply and the current thinking on the reform journey ahead.

The proposed model also includes a move from the current system of provider approvals to a new registration model. It includes 6 new registration categories based on service type. The new regulatory model proposes that the strengthened Quality Standards will be applied flexibly across the different service categories. 

To help providers understand the changes, we compared the current Quality Standards with the draft strengthened Standards. You can read the Strengthened Quality Standards Framework Analysis (current as at 20 June 2023) to learn about the changes.

You can find more information on how we will support providers to prepare for the new regulatory model and strengthened Quality Standards on our website. You can also watch the recording and view the presentation slides from our webinar on our Stronger Standards, Better Aged Care program.

Home Care Packages wage subsidy increase

The Government is funding the Fair Work Commission’s recommendation for a 15% wage increase for aged care workers. The aged care workers whose wages will increase include registered nurses, enrolled nurses, assistants in nursing, personal care workers and home care workers.

For home care providers, the Government has increased the Home Care Packages (HCP) subsidy rate to cover the cost of the wage increase from 1 July 2023. The increased subsidy also covers other increases in prices, such as the annual increase to care management and package management charges. 

The Minister for Aged Care, the Hon Anika Wells MP has recently written to all HCP consumers to let them know about the increase to the home care subsidy. You can read a copy of the letter on the Department of Health and Aged Care's website. 

Some providers will be able to apply for a grant for extra support to meet the wage increases. The grants will be available for providers with consumers on a level 4 package, whose packages fully go towards nursing and personal care each month.

What will providers need to do? 

If HCP providers need to adjust their pricing models and reasonably increase charges for care and services, they must first talk to their consumers, or their representatives, and get their consent. 

Any proposed changes must be discussed with the consumer or their authorised representative before the changes are made. Providers must make sure that the consumer understands and agrees to the changes and their impact on their HCP.

The Commission has developed resources including detailed guidance to help providers and consumers when changing pricing and agreements:

The Department of Health and Aged Care also has resources on its website about the price increases:

Quarterly Financial Reports: due 4 August 2023 

Our April edition of Financial and Prudential Regulatory Insights discussed why provider reporting obligations matter. Quarterly reporting is an opportunity for providers to track activities and patterns that are important to deliver high-quality and safe care.

The Commission is responsible for making sure that providers comply with their annual and quarterly reporting obligations. The data and information they report on is used to understand provider risk.

The Quarterly Financial Report (QFR) for quarter 4 (April­–June 2023) is due 4 August 2023. You can log into the Forms Administration portal from 1 July 2023 to submit your QFR.

If a provider fails to lodge a complete QFR by the due date, we may take regulatory action.

You can find more information on QFR on the Forms Administration portal. If you’re having difficulty with the portal, please contact Forms Administration.

SIRS decision support tool includes home services incidents 

The Serious Incident Response Scheme (SIRS) expanded on 1 December 2022 to include home services and flexible care delivered in a home or community setting. The Commission’s SIRS decision support tool was updated to reflect the differences in the definitions of 4 of the 8 reportable incident types for home services settings.

This tool is particularly useful if you only provide home services and may be reporting serious incidents to us for the first time. It can help you improve your understanding of the SIRS, and the difference between Priority 1 and Priority 2 incidents. 

You can access the decision support tool on our website.

First select your service type (home services or residential care). Then answer a series of questions about an actual, alleged or suspected incident to see if you need to report it to us. 

For detailed information about your SIRS responsibilities, see our: 

You can also find further guidance on our SIRS provider resources page. 

Food, nutrition and dining

A voice and a choice: Enhancing resident food and dining experiences

Food and the experience of eating are important and enjoyable facets of everyday life for most people. Getting to choose what you want to eat is something most people take for granted. These ‘simple’ things are no less important for residents in aged care homes. A well-prepared and thoughtfully served meal can make people feel cared for, comforted and connected. It can help them want to eat. 

As reflected in the Commission’s recent report, Analysis of food and dining experiences in residential aged care services, people bring a range of tastes, practices and attitudes regarding food with them on entry to long-term care settings.  

It’s therefore vital that residents’ individual preferences for food are understood, and that choice is offered and encouraged as part of their overall care and wellbeing. It’s also important to know and detect what residents don’t like and don’t want, and to avoid giving it to them. Staff can notice when a resident doesn’t like, or refuses, foods even when the resident can’t tell them.  

There are many ways you can support and encourage residents to have a voice about their food and dining experience – you can access great resources and read some examples on our website.

Clinical update

Clinical alert on medication transcribing and dispensing errors

On 20 June, the Commission’s Chief Clinical Advisor, Dr Melanie Wroth issued a clinical alert on preventing medication transcribing and dispensing errors in residential aged care. The alert followed the preventable death of an aged care resident as a direct result of being given medications that weren’t prescribed for them.

The coroner's report noted the resident’s death was due to a series of systemic errors and a wholesale lack of adequate checks and balances being undertaken when the service changed from their paper-based, handwritten medication charts to an electronic medication management system.

The circumstances of this death also highlight how important it is for all residential aged care services to make sure that they have strong protocols in place to prevent medication errors. 

Providers must make sure the 6 ‘rights’ of administering medication are carried out every time:

  1. the right medication
  2. the right dose 
  3. the right person
  4. the right time 
  5. the right route 
  6. the right documentation. 

COVID-19 vaccine booster advice

The Chief Medical Officer, Professor Paul Kelly and Commissioner Janet Anderson have written to all aged care providers to encourage and facilitate residents, care recipients and workers to get the 2023 COVID-19 booster dose. You can view the letter on our website.

Currently, just over half of eligible aged care residents have received a booster dose. Yet COVID-19 is still prevalent in the community and continues to have a more severe impact on older people, including those living in residential aged care homes. A significant proportion of all deaths associated with COVID-19 continue to occur in people over 80 years old. It is recommended that everyone should have a booster vaccine 6 months after your last vaccine or 6 months after you have been infected with COVID-19.

There are many ways to get a COVID-19 booster this winter:

  • Book an appointment with your GP or pharmacist
  • By text: the Easy Vaccine Access (EVA) service is an easy way to book your COVID-19 vaccination. Text ‘Hey EVA’ to 0481 611 382 to get a call back from a call agent
  • By phone: 1800 020 080 is a 24-hour helpline that can help you find a vaccine clinic and give you contact information to make a booking
  • Find a health service that provides vaccinations on the Online service finder.

The Older Persons Advocacy Network (OPAN) has created a short video to answer questions that people might have about getting a booster vaccine. In the video Val Fell, a member of the OPAN National Older Persons Reference Group, asks Professor Michael Kidd AO, Deputy Chief Medical Officer and Principal Medical Advisor to Department of Health and Aged Care, about the importance and benefits of booster vaccines.

Watch the OPAN video to find out more.

World Continence Week 2023: Help and advice is a phone call away 

Incontinence is a common condition and, although it can affect people at any age, it's more common in older people. This year’s World Continence Week, from Monday 19 to Sunday 25 June, is a good reminder to assess how your service manages this issue for the people you provide care to. Research shows that: 

  • 73% of aged care residents have urinary incontinence
  • 54% of aged care residents have faecal incontinence
  • around half of all aged care residents have constipation at any given time.

The Commission is joining with the Continence Foundation of Australia, the peak body promoting bladder and bowel control health, to remind providers that incontinence is not just a women’s issue. Even more importantly, it’s not an inevitable part of ageing.

Older Australians may experience periods of incontinence for multiple reasons, but with the right professional advice and dignified person-centred care, it can be managed, improved and sometimes resolved.

More information

Help is just a phone call away. Call the National Continence Helpline (1800 33 00 66) to speak with a Nurse Continence Specialist for free and confidential advice for your service.

The Continence Foundation of Australia has also developed a comprehensive care model called Continence SMART Care.

Find out more about World Continence Week.

Webinars

Compliance in practice 

Register now for our next monthly webinar on Tuesday 18 July from 1.00pm – 2.00pm AEST.

Through our contact with providers, the Commission is aware that providers have different levels of understanding about why, when, and how the Commission exercises its enforcement powers. In this webinar we will explain the process we follow before we decide to take formal regulatory action, and what a provider can expect when we do that. 

The webinar will include a Q&A session and participants are encouraged to submit questions in advance when they register.

Registrations are open on our webinars page.

Webinar recording available – Stronger Standards, Better Aged Care

The recording and presentation slides from our Stronger Standards, Better Aged Care Program webinar, on 20 June, are now available.

Hosted by Commissioner Janet Anderson, the webinar discussed what the Commission is doing to prepare the sector and how we will support the rollout of the strengthened Quality Standards. Panellists included:

  • Lisa Peterson, Assistant Commissioner, Sector Capability, Aged Care Quality and Safety Commission
  • Emma Jobson, Executive Director, Regulatory Policy and Intelligence, Aged Care Quality and Safety Commission
  • Josh Maldon, Assistant Secretary, Choice and Transparency Branch, Department of Health and Aged Care
  • Tim Humphries, Chief Executive Officer, Homestyle Aged Care Services
  • Jane Pappin, Managing Director, Pop-Up Health.

Further information on the Stronger Standards, Better Aged Care Program is on our website.

Governing for reform

Hear from our platinum participants

Every leader in aged care plays a vital role in ensuring the delivery of safe and quality care to older Australians. This is most reliably and effectively achieved through strong corporate and clinical governance.

The Governing for Reform in Aged Care program provides a tailored learning pathway that supports in-depth learning in relation to critical leadership and governance challenges.

Completing the program, participants can expect to:

  • have improved knowledge and skills in aged care governance
  • have confidence in your ability to lead cultural change
  • be inspired by peers and exemplars
  • establish a network of peers and ongoing shared accountability
  • take an experimental approach to improved governance
  • have clear goals and strategies for continuous improvement.

Governing for Reform in Aged Care Program platinum participants recently shared why they believe executives and governing body members should enrol in the program:

“When our organisation saw the scope of what was available, we realised this was an invaluable resource.” – David Maywald, Board Director at Community Services #1.

“It helps you reflect on questions and issues that an effective Board Director would be examining as part of their Board accountabilities. In a world full of information, this Program provides a reliable and credible information source that can be trusted.” – Illana Halliday, Board Director at Scalabrini Villages.

“It enables self-directed learning and explains the need for good governance for the benefit of older Australians.” – Michelle Schupelius, CEO of Wheatfields Residential Care. 

To join hundreds of executive leaders and governing body members who have committed to governing for reform, sign up for the Governing for Reform in Aged Care Program and start your learning journey today.

Training and resources

Did you know that you can access Alis for free?  

If you’re an approved provider, or work for an approved provider, you can access our online learning platform – Aged Care Learning Information Solution (Alis) – for free. As soon as an organisation is formally approved to provide Government-subsidised aged care services, that provider is eligible to access Alis. You don’t have to wait until after your first audit by the Commission. 

If you experience any difficulties with accessing the platform, please let us know by emailing us at education@agedcarequality.gov.au.

Not an approved provider? Your organisation can access Alis by registering and paying a modest licence fee per learner. The current fee is $30 per person annually.  

Alis supports aged care workers and providers with resources and e-learning modules specific to aged care. Our content helps people working in aged care to understand their obligations and responsibilities so they can provide safe, high-quality care.

We currently have 71 modules on Alis. We keep you updated by uploading new modules to reflect the changing demands of the aged care sector.  

You can register yourself as a learner or provide an expression of interest for your organisation on the Alis website. 

Encouraging people to ask for what they need from aged care services

The Centre for Cultural Diversity in Ageing has produced a video to encourage older people from diverse backgrounds to ask for what they need from their aged care service. The video is available in 16 different languages, including Arabic, Simplified Chinese, Hindi, Serbian and Vietnamese.

The video project was developed with Partners in Culturally Appropriate Care funding from the Department of Health and Aged Care. The Centre for Cultural Diversity in Ageing and Red Hat Films produced the video with support from Australian Multicultural Community Services and Elder Rights Advocacy.

You can watch and share the video from the Centre for Cultural Diversity in Ageing YouTube channel.

Online workshops for approved providers

The Commission regularly hosts online workshops for approved providers of residential aged care and home services.

Upcoming workshops in July include:

  • The Serious Incident Response Scheme (SIRS) within residential and home services
  • Effective Incident Management Systems
  • Understanding the Quality Standards
  • Home services – 5 key areas of risk.

Visit our Workshops webpage for further information and registration details.

New resources

Was this page useful?
Why?
Why not?
Share this page
 

Acknowledgement of Country

In the spirit of reconciliation, the Aged Care Quality and Safety Commission acknowledges the Traditional Custodians of Country throughout Australia and their connections to land, water and community. We pay our respect to their Elders, past, present and emerging and extend that respect to all Aboriginal and Torres Strait Islander peoples.